The Supreme Court of Ohio ruled today that a truck driver who was awarded state workers’ compensation benefits for physical injuries he suffered in a work-related traffic accident is not eligible to receive workers’ compensation benefits for post-traumatic stress disorder (PTSD) related to that accident because his PTSD was not caused by his compensable physical injuries.

The court’s 5-2 decision, authored by Justice Judith L. French, affirmed a ruling of the Second District Court of Appeals.

The case involved a 2009 accident in which another vehicle crashed into the back of a stopped dump truck being operated by Shaun Armstrong in the course of his employment with the John Jurgenson Company. Armstrong watched the other vehicle approaching at high speed and braced himself for the collision, afraid that he was going to be seriously injured.

After the collision, Armstrong was in shock and did not know the extent of his injuries. Looking in his mirror, Armstrong saw the other driver with his head down and observed fluid leaking from the vehicles. Armstrong exited the dump truck, afraid the vehicles would catch fire, and called 9-1-1. Armstrong then noticed that the other driver was not moving and that blood was coming from his nose; he suspected the driver was dead. After being transported to the emergency room, Armstrong was treated for physical injuries and released. He was distressed to learn, while in the emergency room, that the other driver had, in fact, died.

Armstrong filed a workers’ compensation claim for his physical injuries, and his claim was allowed for cervical strain, thoracic strain, and lumbar strain. He subsequently requested an additional allowance for PTSD. A Bureau of Workers’ Compensation (BWC) staff hearing officer allowed Armstrong’s additional claim, finding that his PTSD was compensable because it was causally related to his industrial injury and his previously recognized conditions.

Jurgensen appealed to the Industrial Commission of Ohio, which refused the administrative appeal. Jurgenson then appealed the PTSD award to the Clark County Court of Common Pleas. The parties stipulated that Armstrong suffers from PTSD, and the trial court conducted a bench trial to determine Armstrong’s right to workers’ compensation benefits for that condition.

The parties presented conflicting expert testimony. Armstrong’s expert, Dr. Jennifer Stoeckel, testified that Armstrong developed PTSD as a result of the accident and that his physical injuries contributed to and were causal factors in his development of PTSD. Jurgensen’s expert, Dr. William L. Howard, stated his opinion that Armstrong’s physical injuries did not cause his PTSD but that the PTSD was caused by Armstrong’s witnessing the accident and “the mental observation of the severity of the injury, the fatality, [and] the fact that it could have been life-threatening to him at some point.” Dr. Howard believed that Armstrong would have developed PTSD even without his physical injuries.

The trial court held that Armstrong’s PTSD was not compensable because it did not arise from his physical injuries. The Second District Court of Appeals affirmed, holding that the applicable statutory definition of “injury” includes psychiatric conditions only when they arise from a compensable physical injury. The court of appeals further determined that competent, credible evidence supported the trial court’s factual finding that Armstrong’s PTSD did not arise from his physical injuries.

Armstrong sought and was granted Supreme Court review of the Second District’s decision. The Ohio Association for Justice (OAJ) submitted an amicus curiae (friend of the court) brief supporting Armstrong’s position.

In today’s majority opinion, Justice French wrote: “Pursuant to the plain language of R.C. 4123.01(C)(1), a claimant must sustain physical injury or occupational disease as a prerequisite to recovering workers’ compensation benefits for a mental condition. A psychiatric condition is not a workers’ compensation injury except when the condition has ‘arisen from an injury or occupational disease sustained by that claimant.’ ... Armstrong and OAJ urge this court to adopt a reading of the term ‘injury’ that embraces the entire episode or accident giving rise to a claimant’s physical injuries. We decline to do so. ... While the cause and underlying circumstances are relevant to the question of compensability, once the prerequisites to coverage are met, it is the resultant harm that constitutes the ‘injury’ received or sustained by the claimant, and it is from that harm that the claimant’s psychiatric condition must arise.”

“Beyond requiring physical injury or occupational disease, R.C. 4123.01(C)(1) also defines the required nexus between the physical injury or occupational disease and a corresponding mental condition. As relevant here, to be compensable, the mental condition must have ‘arisen from an injury ... sustained by th[e] claimant.’ (Emphasis added.) ... ‘Arisen from,’ as used in R.C. 4123.01(C)(1), contemplates a causal connection between the mental condition and the claimant’s compensable physical injury. ... Based on the language of R.C. 4123.01(C)(1), the court of appeals held that ‘[t]o be compensable, a psychiatric condition must have been started by and therefore result from a physical injury or occupational disease the claimant suffered.’ ... We agree, reading these terms together in context, that the statute requires a causal connection between a claimant’s physical injury and the claimant’s mental condition.”

“Armstrong undisputedly suffered compensable physical injuries as a result of the accident, and his PTSD undisputedly arose contemporaneously as a result of the accident. For Armstrong’s PTSD to qualify as a compensable injury under R.C. 4123.01(C)(1), however, more is required; he must establish that his PTSD was causally related to his compensable physical injuries and not simply to his involvement in the accident.

“The record contains contradictory evidence of whether Armstrong’s physical injuries were a contributing cause of his PTSD. Dr. Howard testified that Armstrong’s physical injuries did not cause his PTSD, while Dr. Stoeckel testified that Armstrong’s physical injuries were causal factors in his development of PTSD. The trial court, having heard all the evidence, found Dr. Howard’s testimony more credible. The court of appeals appropriately determined that the record contains competent, credible evidence supporting the trial court’s finding that Armstrong’s physical injuries did not cause his PTSD and that Armstrong’s PTSD is, therefore, not a compensable injury under R.C. 4123.01(C)(1). For these reasons, we affirm the judgment of the court of appeals.”

Justice Pfeifer wrote: “In McCrone v. Bank One Corp. (2005) ... (t)his court stated, ‘In mental injury claims, the problem arises of establishing the existence of the injury itself. Although a physical injury may or may not cause a psychological or psychiatric condition, it may furnish some proof of a legitimate mental claim.’ (Emphasis added.) ... Thus, the court concentrated not on causation, but on the evidence that a contemporaneous physical injury provides that supports the existence of a psychological injury. In this case, we have no issue of proof. Armstrong’s employer stipulates that Armstrong suffers from post-traumatic stress disorder ... and there is no dispute that the accident occurred while Armstrong was on the clock and performing job-related duties. Armstrong suffered a contemporaneous physical injury ... Why shouldn’t Armstrong recover?”

“Where does today’s decision leave employees who suffer from PTSD? If an employee is horribly injured in an accident, can he receive compensation only for being depressed over the state of his body but not for psychological injuries due to being haunted by the trauma of the original event? Are those the kind of distinctions the General Assembly really intended—depression over injuries is compensable but psychological effects arising from the accident causing the traumatic injuries is not? Is it not enough that a worker’s broken body provides the ‘proof’ of psychological injury that this court said the statute requires in McCrone, proof that a specific traumatic event has occurred? Hasn’t Armstrong paid the required pound of flesh?”

In his dissent, Justice O’Neill wrote: “(T)his case presents a perfect opportunity to right a wrong in the area of workers’ compensation law. The claimant here was involved in a truly gruesome motor-vehicle accident, in the course and scope of his employment, which left him traumatically psychologically impaired. He witnessed the sudden death of a fellow motorist, and he suffers as a result of that accident to this day. That is what the record reflects. From a legal-analysis standpoint, it is wholly irrelevant whether the psychological condition arose from the accident or from the trauma and drama incident to the allowed physical injuries. Either way he was injured in the course and scope of his employment. It is that simple.”

“The reality is that there is no constitutionally adequate explanation for the practice of treating psychologically traumatized workers in a distinctly different manner from their counterparts who, for example, break their arm or leg. It is government-sanctioned discrimination with tragic results, as demonstrated by this case. ... From an examination of the relevant code section, the conclusion I reach is consistent with the law. R.C. 4123.01(C)(1) allows for psychiatric conditions to be compensable as long as the condition arose from an injury sustained by the claimant. ... (U)nlike the majority, I believe it is sufficient that the psychological injury occurred contemporaneously with the physical injury.”

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